thank you.
Did I ask for for the correct documents?
All patients seen for the month i'm auditing
All bills that went out to ins. co.
all remittances
all denials.
Do you think I will find claims that were not paid? I'm actually auditing a office that we just took over.
I so appreciate your help!
Laurie
Oh, no! You've got your work cut out for you, that's for sure...You mean to tell me that no one follows up on claims after they're sent, to make sure they get paid? I'd hate to imagine how much money's being lost, there. I'd be extremely surprised if you don't find any outstanding money...
What are you auditing, exactly? Billing accuracy? Documentation accuracy? Everything?
For documentation audits (retrospective):
Start by pulling 10-15 charts, and code them. Then pull the billing records to see how it was billed, and if it paid. You may need to submit corrections/refunds. For the first couple that you do, I'd suggest only pulling encounters from the past 90 days, so that you can make corrections within your filing deadlines.
You could also do prospective, which is basically the same thing, except that you hold the claims until the audit is complete. That way, you can make necessary changes before the payors ever see the charges. I would only recommend prospective for really small practices, or as a remedial measure for providers who have had bad audit scores in the past. Otherwise, it's really not practical.
For billing/payment audits, you should review all of the claims submitted during a certain time frame (30 days, 60 days, etc.) - separate them by payor. Calculate the percentage of denied claims based on reasons (modifier, patient benefits, diagnosis, etc.), so you can have an idea of what mistakes are being made, and how many could have been prevented.
If you don't already have it, you might suggest that the doctor invest in a billing system that can keep track of all of that for you. We use GroupCast Centricity by GE, and we have another program called Anodyne Analytics that works with it. You can run basically any kind of report you can dream up, and it has task queues for people to follow up on outstanding/denied claims. I'm sure there are other great software manufacturers out there for that kind of stuff; you'd just have to research it to find the one that would work best at your practice. It's worth the expense - trust me. Good luck!